Q: I was diagnosed with Hashimoto’s disease a year after I had a hysterectomy. Could you address this subject and explain the earning signs and treatment? I would like people to be aware of the symptoms and for their families to understand the impact this disease has on a person. Thank you.
A: There are a number of thyroid abnormalities and conditions, including hypothyroidism, hyperthyroidism, Graves’ disease, and Hashimoto’s, also known as chronic lymphocytic thyroiditis, which is chronic inflammation of the thyroid gland. The thyroid is a small butterfly-shaped gland in the front of the neck below the larynx. It produces two hormones, triiodothy known as T3 and thyroxine known as T4. These hormones affect brain development, the rate at which our hearts beat, metabolism, muscle strength, weight, menstrual cycles, cholesterol levels, and even the act of breathing.
Thyroid hormone production is regulated by yet another hormone known as thyroid stimulating hormone known as TSH and is produced by the pituitary gland. When thyroid hormone levels are low, the pituitary kicks into high gear and produces additional TSH. When levels are high, TSH production is lowered.
Hashimoto’s is an autoimmune disorder, meaning the body’s immune system incorrectly attacks its own tissues and cells, interfering with their ability to manufacture thyroid hormone. It is the most common cause of hypothyroidism in adults. Symptoms can progress gradually over months or years. Many individuals with Hashimoto’s disease are initially symptom-free but as the disease progresses, the thyroid enlarges and the front of the neck may appear swollen. The abnormal swelling of the gland, referred to as a goiter, is not painful but may give a feeling of fullness in the throat. With the passing of time and I do mean time, (years or decades), the damaged thyroid will shrink and the goiter will disappear. Not all cases of Hashimoto’s will develop into hypothyroidism and not all goiters are from Hashimoto’s. When they do, symptoms may include joint and muscle pain, dry/thinning hair, weight gain, fatigue, depression and a decrease in heart rate. When left untreated, serious complications can result. The disease is more common in women than in men, and in those between the ages of 40 and 60. It tends to run in families.
The exact cause of the disease is unknown but factors include it having a genetic predisposition. There is no cure for Hashimoto’s; however, hormone replacement with oral medication can regulate hormone levels and restore normal metabolism. Dosing will depend on the severity of the hypothyroidism, other medical conditions that may be present, the person’s age and his or her weight.
Diagnosis is made by visual examination and laboratory testing to include a T3, T4 and TSH. This blood work, along with a test of antibodies against the thyroid gland itself, can determine the possible presence of antibodies focused toward the thyroid, indicating Hashimoto’s; however, it will not detect any presence of cancer. As a general rule, imaging studies are not ordered but fine needle biopsy, ultrasound and a radioactive uptake scan might further assist a physician make a proper diagnosis.
Treatment depends on whether the thyroid is sufficiently damaged to cause hypothyroidism. If so, synthetic T4 is prescribed because it remains in the body longer than does T3 and the body can receive a sufficient dosing throughout the day. Because thyroid hormones act slowly in the body, several months may pass before the goiter shrinks. The prognosis is good for the disease but not necessarily the goiter, if there is one. There is no method by which a person can prevent Hashimotos but those with a family history should be aware of symptoms and visit their physician if they become suspicious..
Readers who would like related information can order Dr. Gott’s Health Report “Thyroid Disorders” by sending a self-addressed, stamped number 10 envelope and a $2 US c heck or money order to Dr. Gott’s Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.
